Australian pop star Kylie Minogue's advocacy for breast cancer brought welcome attention to the disease, but also led to many women getting unnecessary medical tests.

Should celebrities be involved in public-health campaigns?

That’s the central question addressed by two public-health experts in the latest installment ofthe “Head to Head” series in the journal BMJ (formerly known as the British Medical Journal).

Arguing for celebrity involvement in public-health campaigns is Simon Chapman, professor of public health at the University of Sydney.

“Those concerned about celebrities in health campaigns invariably point to examples that have gone badly wrong or that fail to change the world forever,” he writes. “They home in on celebrity endorsement of flaky complementary medicine or quack diets, ridicule incidents where celebrities have wandered off message or blundered, or point out cases where celebrity ‘effects’ are not sustained, a problem not confined to campaigns using celebrities. But they are silent about the main examples of celebrity engagement that have massively amplified becalmed news coverage about important neglected problems or celebrity involvement in advocacy campaigns to promote evidence based health policy reform.”

Oddly, Chapman provides only two examples of celebrities who have helped with public-health messages: British reality-show celebrity Jade Goody, whose death from cervical cancer in 2009 helped raise awareness about that disease, and Australian pop star Kylie Minogue, whose 2005 diagnosis of breast cancer at the age of 36 led to an increase in the number of British women seeking mammography screening.

Unfortunately, as Chapman acknowledges, many of the women who sought mammograms after Minogue’s diagnosis were at very low risk of developing breast cancer and thus risked being exposed to unnecessary radiation and treatments from false-positive results. (A survey taken a year after Minogue announced her cancer found that one-third of British women mistakenly believed breast cancer was more likely in women under age 50 than in those over that age.)

Still, he says, although “ambivalence about ‘the Kylie effect’ reflects enduring debate about the wisdom of breast screening, … it should not blind us to the potential value of celebrity engagement in important causes.”

Celebrities 'bring compelling authenticity'

“Celebrities are not experts,” Chapman adds. “They can use embarrassingly naïve language and may have no idea about levels of evidence or all the work that has gone before. But playing to the media’s appetite for those experiencing health problems, celebrities often speak personally and bring compelling authenticity to public discourse.”

Arguing against the usefulness of celebrity involvement in public-health campaigns is Geof Rayner, a public-health researcher and policymaker who is now an honorary research fellow at City University London. “It’s not until you start delving into the role of celebrity culture on health that the negatives begin to stack up,” he writes.

For Rayner, modern celebrities, including politicians, are “icons of rampant consumerism and fantasy lifestyle,” and, thus, inappropriate messengers for public-health campaigns.

“The mingling of celebrity, business, and politics is hardly new,” he writes. “Possibly the first to employ the power of persons to sell products was Lydia Pinkham (1819-93), America’s first female millionaire. Her bottled restorative elixir for women (in fact, a 40% proof spirit) carried her face, making her recognizable to millions. Her modern analogue could be the actress Gwyneth Paltrow, who through her website encourages her fans to purchase ‘doctor-formulated’ patent remedies like protein shakes and food supplements. Thankfully, her widely promoted colon cleansing routines do not form part of the package.”

Thankfully, indeed.

A need for new strategies

Raynor believes that public-health campaigns need to adopt new strategies — ones that rely not on celebrity but on “the lobbying power of thousands of ordinary people through the internet.”

“In the future health campaigners must be nimble across the multiple levers of change. Rather than relying on media stunts they need to look to legal action and perhaps more local campaigns — by us, not for us. We can draw inspiration from the old sanitarian movement, whose campaign to clean up a dirty world succeeded, often with unpopular people at the helm.”

“Modern health campaigners need to go on the offensive against junk food, alcohol, gambling, and other often celebrity linked commercial propaganda,” he adds. “Some celebrities might help, but let’s not look for saviours, buoyed by the happy thought that the work is done when a celebrity is involved.”

BMJ published these two latest “Head to Head” essays on Tuesday. Unfortunately, both are behind the journal’s paywall.